The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias

Fig. 1.. Late gadolinium enhancement pattern in myocardial infarction. Different extent of myocardial infarction on phase-sensitive inversion recovery (PSIR) late gadolinium enhancement images. (A) mid-ventricular short axis slice showing a subendocardial infarction, ∼50% wall thickness in the mid-inferior wall (arrow); (B) horizontal long axis view showing a subendocardial infarction, ∼75% wall thickness in the basal anterolateral wall (arrow); (C) left ventricular outflow tract view showing two large transmural myocardial infarctions, one involving the anteroseptum and apex and one affecting the inferolateral wall (arrows), with an apical thrombus (arrowhead).

Fig. 2.. Late gadolinium enhancement pattern in dilated cardiomyopathy. Mid-ventricular short-axis (A) and horizontal long axis (B) late gadolinium enhancement images in a patient with dilated cardiomyopathy, severely dilated left ventricle and extensive mid-wall fibrosis. (C) monomorphic non-sustained ventricular tachycardia on an electrocardiogram rhythm strip from the same patient. BPM, beats per minute; HR, heart rate; VT, ventricular tachycardia.

Fig. 3.. Types of hypertrophy and late gadolinium enhancement patterns in hypertrophic cardiomyopathy. Severe asymmetrical septal hypertrophy (A), with extensive patchy and hazy LGE in the septum and both right ventricular insertion points (arrows) (B) in a patient with hypertrophic cardiomyopathy and atrial fibrillation (C). Severe anteroseptal hypertrophy (D) with patchy and hazy LGE around the anterior right ventricular insertion point (arrow) (E) in a patient with hypertrophic cardiomyopathy and first-degree atrioventricular block (F). LGE, late gadolinium enhancement.

Fig. 4.. CMR in a patient with arrhythmogenic cardiomyopathy. (A) The right ventricle is dilated with dyskinetic areas in systole (white arrows) on the horizontal long axis view. (B) Late gadolinium enhancement in both the right ventricular free wall and ventricular septum (black arrow). (C) T-wave inversion in leads V1–V4 and epsilon waves (black arrows) on baseline electrocardiogram. (D) Three months after the CMR scan the patient presented with sustained ventricular tachycardia. CMR, cardiac magnetic resonance.

Fig. 5.. CMR in a patient with cardiac amyloidosis. (A,D) Horizontal long-axis and mid-ventricular short-axis SSFP images showing concentric left ventricular hypertrophy. (B,E) Late gadolinium enhancement images showing extensive subendocardial enhancement, enhancement of right ventricular and atrial walls, and the characteristic appearance of a dark blood pool. (C,F) mid-ventricular short-axis images on ShMOLLI T1-mapping, demonstrating multiple areas with increased T1 values (yellow/red areas within the myocardium) due to the deposition of amyloid fibrils. (G) The patient presented with atrial fibrillation and complete heart block. CMR, cardiac magnetic resonance; SSFP, steady-state free precession.

Fig. 6.. Late gadolinium enhancement pattern in myocarditis. Subepicardial/mid-wall enhancement in the inferolateral left ventricular wall (arrows) on short-axis and 3-chamber late gadolinium enhancement images (A, B) in a patient with previous myocarditis and frequent ventricular ectopics (C).

Fig. 7.. CMR imaging in a patient with cardiac sarcoidosis. Large patches of mid-wall late gadolinium enhancement in the anterior, inferolateral and inferior left ventricular walls (white arrows) (A) in a patient with cardiac sarcoidosis and episodes of complete heart block (D). Co-localized myocardial edema seen as brighter areas on T2-mapping (B; black arrows) and T2-weighted images (C; white arrows). CMR, cardiac magnetic resonance.

Fig. 8.. CMR imaging in a patient with repaired tetralogy of Fallot. Vegetation on the pulmonary valve homograft (arrowhead) seen in diastole (A) and in systole (B). The white arrow shows the RVOT patch repair. The patient presented with frequent premature supraventrilucar and ventricular contractions (C). RVOT, right ventricular outflow tract. CMR, cardiac magnetic resonance.

Fig. 9.. ECG gating with and without arrhythmia detection. (A) retrospective ECG gating in a patient with sinus rhythm. (B,C) With arrhythmia detection, data are acquired from cycles where the R wave falls during the RR interval and trigger window set by the operator (red arrow), while data during any other interval are ignored (C). ECG, electrocardiogram.

Fig. 10.. Motion-corrected LGE imaging. (A) Impaired quality on horizontal long axis breath-hold LGE image, which is significantly improved using a motion-correction free-breathing LGE sequence (B) in a patient with atrial fibrillation (C). LGE: late gadolinium imaging.